1. Once-per-week selinexor, bortezomib, and dexamethasone versus twice-per-week bortezomib and dexamethasone in patients with multiple myeloma (BOSTON): a randomised, open-label, phase 3 trial
- Author
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Vesselina Goranova-Marinova, Eirini Katodritou, Mamta Garg, Michael G. Kauffman, Paul G. Richardson, Lingling Li, Monica Galli, Sosana Delimpasi, Sebastian Grosicki, Jelena Bila, Galina Salogub, Dinesh Kumar Sinha, Holger W. Auner, Larry D. Anderson, Sybiryna Korenkova, Don A. Stevens, Melina Arazy, Reuben Benjamin, Supratik Basu, Jacqueline Jeha, Moshe Yair Levy, Artur Jurczyszyn, Nizar J. Bahlis, Jean Richard Saint-Martin, Jatin P. Shah, Hang Quach, Anna M. Liberati, Tuphan Kanti Dolai, Iryrna Kriachok, Roman Hájek, Anita A. Joshi, Darrell White, Michele Cavo, Sundar Jagannath, Meletios A. Dimopoulos, Xavier Leleu, Hanna Oliynyk, Pawel Robak, Maryana Simonova, Ganna Usenko, Ludek Pour, Maria V. Mateos, Ivan Spicka, Moshe E. Gatt, Atanas Radinoff, Craig T. Wallington-Beddoe, Jeevan Kumar, Vishnuvardhan Peddagali, Halyna Pylypenko, Thierry Facon, Christopher P. Venner, Donna E. Reece, Sharon Shacham, Maria Gavriatopoulou, Yi Chai, Mercedes Gironella, Vadim A Doronin, P. Moreau, Karyopharm, Grosicki S., Simonova M., Spicka I., Pour L., Kriachok I., Gavriatopoulou M., Pylypenko H., Auner H.W., Leleu X., Doronin V., Usenko G., Bahlis N.J., Hajek R., Benjamin R., Dolai T.K., Sinha D.K., Venner C.P., Garg M., Gironella M., Jurczyszyn A., Robak P., Galli M., Wallington-Beddoe C., Radinoff A., Salogub G., Stevens D.A., Basu S., Liberati A.M., Quach H., Goranova-Marinova V.S., Bila J., Katodritou E., Oliynyk H., Korenkova S., Kumar J., Jagannath S., Moreau P., Levy M., White D., Gatt M.E., Facon T., Mateos M.V., Cavo M., Reece D., Anderson L.D., Saint-Martin J.-R., Jeha J., Joshi A.A., Chai Y., Li L., Peddagali V., Arazy M., Shah J., Shacham S., Kauffman M.G., Dimopoulos M.A., Richardson P.G., and Delimpasi S.
- Subjects
Male ,medicine.medical_treatment ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Gastroenterology ,Dexamethasone ,multiple myeloma, Selinexor, dexamethasone ,Bortezomib ,0302 clinical medicine ,hemic and lymphatic diseases ,Antineoplastic Combined Chemotherapy Protocols ,030212 general & internal medicine ,Multiple myeloma ,11 Medical and Health Sciences ,education.field_of_study ,General Medicine ,Middle Aged ,Progression-Free Survival ,Hydrazines ,XPO1 ,Female ,Multiple Myeloma ,Life Sciences & Biomedicine ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,Population ,Antineoplastic Agents ,Drug Administration Schedule ,03 medical and health sciences ,Medicine, General & Internal ,Internal medicine ,General & Internal Medicine ,medicine ,Humans ,Progression-free survival ,education ,Aged ,Chemotherapy ,Science & Technology ,business.industry ,Triazoles ,medicine.disease ,EFFICACY ,Regimen ,Proteasome inhibitor ,business ,PERIPHERAL NEUROPATHY - Abstract
Summary Background Selinexor combined with dexamethasone has shown activity in patients with heavily pre-treated multiple myeloma. In a phase 1b/2 study, the combination of oral selinexor with bortezomib (a proteasome inhibitor) and dexamethasone induced high response rates with low rates of peripheral neuropathy, the main dose-limiting toxicity of bortezomib. We aimed to evaluate the clinical benefit of weekly selinexor, bortezomib, and dexamethasone versus standard bortezomib and dexamethasone in patients with previously treated multiple myeloma. Methods This phase 3, randomised, open-label trial was done at 123 sites in 21 countries. Patients aged 18 years or older, who had multiple myeloma, and who had previously been treated with one to three lines of therapy, including proteasome inhibitors, were randomly allocated (1:1) to receive selinexor (100 mg once per week), bortezomib (1·3 mg/m2 once per week), and dexamethasone (20 mg twice per week), or bortezomib (1·3 mg/m2 twice per week for the first 24 weeks and once per week thereafter) and dexamethasone (20 mg four times per week for the first 24 weeks and twice per week thereafter). Randomisation was done using interactive response technology and stratified by previous proteasome inhibitor therapy, lines of treatment, and multiple myeloma stage. The primary endpoint was progression-free survival in the intention-to-treat population. Patients who received at least one dose of study treatment were included in the safety population. This trial is registered at ClinicalTrials.gov , NCT03110562 . The trial is ongoing, with 55 patients remaining on randomised therapy as of Feb 20, 2020. Findings Of 457 patients screened for eligibility, 402 were randomly allocated—195 (49%) to the selinexor, bortezomib, and dexamethasone group and 207 (51%) to the bortezomib and dexamethasone group—and the first dose of study medication was given between June 6, 2017, and Feb 5, 2019. Median follow-up durations were 13·2 months [IQR 6·2–19·8] for the selinexor, bortezomib, and dexamethasone group and 16·5 months [9·4–19·8] for the bortezomib and dexamethasone group. Median progression-free survival was 13·93 months (95% CI 11·73–not evaluable) with selinexor, bortezomib, and dexamethasone and 9·46 months (8·11–10·78) with bortezomib and dexamethasone (hazard ratio 0·70 [95% CI 0·53–0·93], p=0·0075). The most frequent grade 3–4 adverse events were thrombocytopenia (77 [39%] of 195 patients in the selinexor, bortezomib, and dexamethasone group vs 35 [17%] of 204 in the bortezomib and dexamethasone group), fatigue (26 [13%] vs two [1%]), anaemia (31 [16%] vs 20 [10%]), and pneumonia (22 [11%] vs 22 [11%]). Peripheral neuropathy of grade 2 or above was less frequent with selinexor, bortezomib, and dexamethasone (41 [21%] patients) than with bortezomib and dexamethasone (70 [34%] patients; odds ratio 0·50 [95% CI 0·32–0·79], p=0·0013). 47 (24%) patients in the selinexor, bortezomib, and dexamethasone group and 62 (30%) in the bortezomib and dexamethasone group died. Interpretation A once-per-week regimen of selinexor, bortezomib, and dexamethasone is a novel, effective, and convenient treatment option for patients with multiple myeloma who have received one to three previous lines of therapy. Funding Karyopharm Therapeutics.
- Published
- 2020